2025 ICD-10-CM code H35.5
(Active) Effective Date: N/A Diseases of the eye and adnexa - Other retinal disorders 7 Feed
Hereditary retinal dystrophy
Medical necessity for services related to hereditary retinal dystrophy (H35.5) is established by demonstrating the progressive nature of the disease and its impact on the patient's vision.This typically involves documenting visual impairment, its impact on daily activities, and the need for ongoing monitoring, low vision aids, or other supportive interventions.
Diagnosis and management of hereditary retinal dystrophy typically fall under the purview of ophthalmologists, specializing in medical and surgical eye care.They perform diagnostic tests like visual field testing, electroretinography, and optical coherence tomography to assess the extent of retinal damage.Genetic testing might be recommended to identify the specific gene mutation causing the dystrophy.While there's currently no cure, ophthalmologists manage the condition by addressing associated symptoms (like vision loss) and recommending low vision aids if needed. They also provide genetic counseling and educate patients about the progression of the disease.
In simple words: This condition is passed down through families and causes the part of your eye that senses light to slowly break down.
A group of inherited disorders characterized by the progressive degeneration of the retina, the light-sensitive tissue at the back of the eye.
Example 1: A 30-year-old patient presents with progressive night blindness and difficulty seeing in dim light.Family history reveals similar symptoms in older relatives.Following a comprehensive eye exam, including electroretinography and visual field testing, the ophthalmologist diagnoses the patient with retinitis pigmentosa, a form of hereditary retinal dystrophy (H35.5)., A 10-year-old child experiences increasing difficulty reading and seeing details.Genetic testing reveals a mutation associated with Leber congenital amaurosis, a severe form of hereditary retinal dystrophy (H35.5) that begins in infancy.The ophthalmologist refers the child to low vision specialists to help adapt to vision loss., A 50-year-old individual with a known family history of cone-rod dystrophy, a type of hereditary retinal dystrophy (H35.5), reports experiencing blurred central vision and difficulty distinguishing colors.Optical coherence tomography confirms macular degeneration, a common feature of the condition.
Documentation should include a detailed family history, patient's reported symptoms, visual acuity measurements, results of ophthalmic examinations (like funduscopy, visual field testing, and electroretinography), and if available, genetic testing results confirming the specific dystrophy.
** Excludes1: dystrophies primarily involving Bruch's membrane (H31.1-)Excludes2: diabetic retinal disorders (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359, E13.311-E13.359)
- Payment Status: Active
- Specialties:Ophthalmology, Optometry, Genetics
- Place of Service:Office, Outpatient Hospital